Comparison of the McGrath？ Series 5 and GlideScope？ Ranger with the Macintosh laryngoscope by paramedics

Thirty paramedics performed six intubations in a randomised order with all three laryngoscopes in an airway simulator with a normal airway. Subsequently, every participant performed one intubation attempt with each device in the same manikin with simulated cervical spine rigidity using a cervical collar. Glottic view, time until visualisation of the glottis and time until first ventilation were evaluated.Time until first ventilation was equivalent after three intubations in the first scenario. In the scenario with decreased cervical motion, the time until first ventilation was longer using the McGrath？ compared to the GlideScope？ and AMacintosh (p < 0.01). The success rate for endotracheal intubation was similar for all three devices. Glottic view was only improved using the McGrath？ device (p < 0.001) compared to using the Macintosh blade.The learning curve for video laryngoscopy in paramedics was steep in this study. However, these data do not support prehospital use of the McGrath？ and GlideScope？ devices by paramedics.Endotracheal intubation remains the preferred technique to secure an airway during prehospital airway management [1]. Conventional direct laryngoscopy with a Macintosh blade is considered to be the standard technique for placing an endotracheal tube. Although adequate training in direct laryngoscopy is an important requirement for emergency medical personnel, the incidence of complications is still high, and the procedure is associated with a high mortality rate. During out-of-hospital emergencies, the incidence of unrecognised oesophageal intubation performed by paramedics has been reported to be as high as 16.7% [2,3].In contrast to conventional direct laryngoscopy using a Macintosh blade, the novel technique of video laryngoscopy allows for a view of the glottis without requiring alignment of the oral, pharyngeal and laryngeal axes.The McGrath？ series 5 video laryngoscope (Aircraft Medical Ltd, Edinburgh, UK) is a novel device designed for endot